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With top hospital cover, you don't have to worry about what treatments are or aren't covered by your health insurance policy. That's because most top policies cover the full suite of medically necessary treatments.
The comfort and convenience of private care really shines when you're giving birth, having your hip replaced, undergoing dialysis, having an insulin pump applied or going through any number of expensive and complicated treatments. Top cover makes that happen for you.
Below you'll find a selection of gold hospital policies from Finder partners. Gold is the top level of health insurance available, and includes cover for pregnancy, IVF, cataracts, joint replacement and more - which aren't covered by other levels of health insurance.
Ready to explore more options? Use our free comparison tool to compare side by side options and quotes from Australian health funds.
There are different levels of private hospital insurance available, but not all of them cover everything you may need, so for complete peace of mind, many people choose to take out top hospital health insurance. This is the highest level of cover available and usually covers private hospital treatment for all services where Medicare pays a benefit. The four levels of hospital cover are:
These four tiers are beginning to be overhauled starting on 1 April 2019 and concluding in April 2020. This means that some health funds already have policies that fall into one of four categories: Basic, Bronze, Silver and Gold, while others are still using the old classification. These somewhat align with the current tiers, but the new system will make it much easier to compare policies side-by-side.
While top hospital cover is more expensive than other levels of private hospital cover, the costs can be offset somewhat by choosing to pay an excess or a co-payment.
An excess is an additional amount you contribute towards the cost of a service, while a co-payment is a daily amount you pay towards your costs for every day you are in hospital. With one or both of these included in your policy, you can substantially reduce the cost of your premiums.
While basic and medium levels of private hospital cover restrict or exclude a range of services, top hospital cover includes every service where Medicare pays a benefit. That means, where lower levels of cover won’t include things like pregnancy and birth related services, assisted reproductive services, cataract and eye lens procedures, joint replacements and renal dialysis, top hospital will cover them all. A good top hospital policy will also cover services like:
Under the new system rolling out in April 2019, many top policies will become known as Gold policies. The major difference is that any policy labelled Gold will be required to offer all of the services above and a host of others or they won't get the Gold label.
Two of the main benefits offered by top hospital private health insurance, that are often not included in lower levels of cover, are assisted reproductive services and cataract and eye-related services. So if you are planning to start a family and are looking at procedures such as IVF (In-Vitro Fertilisation) or GIFT (Gamete Intrafallopian Transfer), both of which can be expensive with no guarantees of success, having top hospital insurance to cover the in-hospital portion of these procedures can be highly beneficial. You will still have some out-of-pocket expenses for services performed outside of hospital, such as specialist visits and various tests, but the hospital part will be covered up to certain benefit limits. Similarly with eye-related services such as cataract removal or refractive lens exchange (RLE), having top hospital cover for the in-hospital portion of the procedure will go a long way towards covering your costs. Medicare provides a rebate for part of the cost and your top hospital insurance will cover some or all of the rest.
Despite providing top level protection, there are some things even top hospital private health insurance will not cover. The main ones are:
The private health insurance industry is currently undergoing a major set of reforms. Some took effect in 2018, but the majority have begun to launch in April 2019, and will continue into April 2020. Here are some of the highlights:
The main thing to be aware of with any of these in-hospital services is that if your doctor or specialist charges more than the Medicare Benefit Schedule (MBS) fee, there is likely to be a “gap” between what Medicare will cover (75% of the MBS fee) and what your top hospital insurance will reimburse you (25% of the MBS fee). This will result in an out-of-pocket expense, unless your health fund has a Medical Gap Scheme to help cover the difference. If your doctor or specialist participates in their particular scheme, then you won’t have to pay any gap costs. It’s important to talk to your fund before being admitted to hospital to make sure you are fully covered by your top hospital insurance. Picture: Shutterstock
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Am I covered for item 49518?
Hi Johannes,
Thank you for your inquiry.
You have contacted finder.com.au, a comparison and information service and not actually an insurer.
MBS item 49518 (knee replacement) can be covered by health insurance but be sure to check that procedure is covered by the fund before making a purchase. You may find our health insurance for joint replacement page helpful.
All the best,
Zubair
what is the cheapest health cover full hospital and extra for couple over 65 . thanks peter
Hi Peter,
Thank you for your question.
Health Insurance quotes depends on the age group of couple and type of cover you’re looking. Through our health insurance quote engine, you can get highest and lowest quotes from different health funds in Australia. While we are able to provide quotes for every fund in Australia, you will only be able to apply for cover with the funds in our panel.
Cheers,
Zubair